Barriers and facilitators to implementing pressure injury prevention and management guidelines in acute care: A mixed-methods systematic review.
Evidence-based pressure injury prevention and management is a global health service priority. Low uptake of pressure injury guidelines leads to compromised patient outcomes. Understanding clinicians' and patients' views on the barriers and facilitators to implementing guidelines and mapping the iden...
| Published in: | International Journal of Nursing Studies Vol. 145 |
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| Main Authors: | , , , , , , |
| Format: | research systematic review Journal Article |
| Published: |
Elsevier B.V.
Sep2023
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=169951364&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 169951364 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00207489 JHV jtl: International Journal of Nursing Studies issn: 00207489 maglogo: N pubinfo: dt: Sep2023 vid: 145 pid: 82545 pub: Elsevier B.V. place: Philadelphia, Pennsylvania artinfo: ui: 169951364 169951364 169951364 10.1016/j.ijnurstu.2023.104557 169951364 ppct: 1 formats: tig: atl: Barriers and facilitators to implementing pressure injury prevention and management guidelines in acute care: A mixed-methods systematic review. aug: au: Wan, Ching Shan Cheng, Heilok Musgrave-Takeda, Mika Liu, Mark Guosheng Tobiano, Georgia McMahon, Jake McInnes, Elizabeth affil: Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia sug: subj: Pressure Ulcer Prevention and Control Acute Care Professional Practice, Evidence-Based Pressure Ulcer Therapy Practice Guidelines Implementation Science Physician Attitudes Patient Attitudes Hospitals Human Systematic Review Medline Embase CINAHL Database Psycinfo Cochrane Library Thematic Analysis Conceptual Framework Professional Knowledge Health Facility Environment Behavior Modification Checklists ab: Evidence-based pressure injury prevention and management is a global health service priority. Low uptake of pressure injury guidelines leads to compromised patient outcomes. Understanding clinicians' and patients' views on the barriers and facilitators to implementing guidelines and mapping the identified barriers and facilitators to the Theoretical Domains Framework and behaviour change techniques will inform an end-user and theoretically informed intervention to improve guideline uptake in the acute care setting. To synthesise quantitative and qualitative evidence on i) hospital clinicians' and inpatients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. A convergent integrated mixed-methods systematic review was conducted using the JBI approach. English language peer-reviewed studies published from 2009 to August 2022 were identified from MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Library. Included studies reported: i) acute care hospital clinicians' and patients' perceptions and experiences of evidence-based pressure injury practices and ii) barriers and facilitators to implementing guidelines. The Mixed Methods Appraisal Tool was used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data, comparing clinicians' and patients' views. Barriers and facilitators associated with each main theme were mapped to the Theoretical Domains Framework and allocated to relevant behaviour change techniques. Fifty-five out of 14,488 studies of variable quality (29 quantitative, 22 qualitative, 4 mixed-methods) met the inclusion criteria. Four main themes represent factors thought to influence the implementation of evidence-based guidelines: 1) nurse-led multidisciplinary care, 2) patient participation in care, 3) practicability of implementation and 4) attitudes towards pressure injury prevention and management. Most barriers identified by clinicians were related to the third theme, whilst for patients, there were multiple barriers under theme 2. Barriers were mainly mapped to the Knowledge domain and Environmental Context and Resources domain and were matched to the behaviour change techniques of "instruction on how to perform a behaviour" and "restructuring the physical environment". Most facilitators mentioned by clinicians and patients were related to themes 1 and 2, respectively, and mapped to the Environmental Context and Resources domain. All patient-related attitudes in theme 4 were facilitators. These review findings highlight the most influential factors related to implementing evidence-based pressure injury care from clinicians' and patients' views and mapping these factors to the Theoretical Domains Framework and behaviour change techniques has contributed to developing a stakeholder-tailored implementation intervention in acute care settings. CRD42021250885. pubtype: Academic Journal doctype: research systematic review Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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